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GENERAL CHANGE ENDORSEMENT <br />This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below: <br />Name of Insurance Company(ies) <br />Atain Specialty Insurance Company Atain Spec Insurance Company 100.0% GenLiab <br />Inception Date Expiration Date <br />11/9/2020 1/31/2021 <br />Endorsement Effective Policy Number Endorsement # <br />11/9/2020 CIP423084 1 <br />Named SantaInsured yr�P�s. � �y,�y. <br />City of Santa Ana �"�� '"'dd �-JJ <br />Countersigned By <br />(Authorized Representative) <br />IN CONSIDERATION OF THE PREMIUM PREVIOUSLY CHARGED, IT IS HEREBY UNDERSTOOD AND AGREED <br />THAT TILE POLICY IS AMENDED AS FOLLOWS: <br />THE SCFIEDULE OF LOCATIONS IS HEREBY VNIENDED TO READ FOR NO FURTHER CHARGE: <br />LOCATIONW : I ST STREE'I'/AI11N ST, SANTA AMA, CA 92701 <br />LOCATION#2: 3RD STREET/MAINST. SANT,4 ANA, CA 92701 <br />LOCATION43: 4TH STREET LOCATION#: IM41NST. SANTAANA, CA 92701 <br />LOCATIONt,14: 3RD STREET/B120ADWAY, SANTA ANA, CA 92701 <br />LOCATION#5: 4THSTREET/BROADJE41' SANTAANA, CA 92701 <br />LOCATION#6: 5THSTREET/BROADPVAY, SANTAANA, CA 92701 <br />LOCATION#7: 4THSTREET/BUSH, SANTAANA, CA 92701 <br />LOCATION#8: 1ST STREE'l/BRISTOL STREET, SANTA ANA, CA 92701 <br />LOCATIONt19: 17TH STREET/BRISTOL STREET, SANTA ANA, CA 92701 <br />LOCATION#10: ANIACARTHUR BLVD/BRISTOL STREET, SANTA ANA, CA 92701 <br />LOCATION#11:MAINSTREET/MCFADDHNAMR, SANTA ANA, CA 92701 <br />LOCATION912: HARBOR BLVD/A11CFADDENAVE., SANTA ANA, CA 92701 <br />LOCATION#13. GRAND/DYER, SANTA ANA, CA 92701 <br />LOCATION#14: 17771 STREET/CENTRE ON 17TH, SANTA ANA, CA 92701 <br />LOCATIONT#15: 1ST STREET/DO PVNTO AWN PLAZA, SANTA ANA, CA 92701 <br />LOCATION916: AdAIAFAVASHINGTON, SANTA ANA, CA 92701 <br />LOCATION917: RAITT/MACARTHUR BLVD., SANTA ANA, CA 92701 <br />LOCATION#18: GREENVILLE/ALTON, SANTA ANA, CA 92701 <br />LOCAMAT#19: MAIN STREET/ PVARNF.R ATIE, SANTA ANA, CA 92701 <br />LOCATION00: FLOWER STREET/BISHOP, SANTA ANA, CA 92701 <br />All other terms and conditions remain unchanged. <br />knhom 12/4/2020 <br />,„� � W MsnsgementDlAslnn <br />°%'" 11 <br />REVIEWED&APPROVEDBY: <br />I <br />^--� Risk Management Analyst <br />10 <br />_. '.r ...r... <br />